Clinical Benefit of Intravascular Imaging Compared With Conventional Angiography in Left Main Coronary Artery Intervention

被引:6
|
作者
Kwon, Woochan [3 ]
Lee, Joo Myung [3 ]
Yun, Kyeong Ho [1 ,6 ]
Choi, Ki Hong [3 ]
Lee, Seung-Jae [4 ]
Lee, Jong-Young [4 ]
Lee, Sang Yeub [7 ,8 ]
Kim, Sang Min [7 ]
Cho, Jae Young [6 ]
Kim, Chan Joon [9 ]
Ahn, Hyo-Suk [9 ]
Nam, Chang-Wook [10 ]
Yoon, Hyuck-Jun [10 ]
Park, Yong Hwan [5 ]
Lee, Wang Soo [11 ]
Jeong, Jin-Ok [12 ]
Song, Pil Sang [12 ]
Doh, Joon-Hyung [13 ]
Jo, Sang-Ho [14 ]
Yoon, Chang-Hwan [15 ]
Kang, Min Gyu [16 ]
Koh, Jin-Sin [16 ]
Lee, Kwan Yong [17 ]
Lim, Young-Hyo [18 ]
Cho, Yun-Hyeong [19 ]
Cho, Jin-Man [20 ]
Jang, Woo Jin [21 ]
Chun, Kook-Jin [22 ]
Hong, David [3 ]
Park, Taek Kyu [3 ]
Yang, Jeong Hoon [3 ]
Choi, Seung-Hyuk [3 ]
Gwon, Hyeon-Cheol [3 ]
Hahn, Joo-Yong [3 ]
Song, Young Bin [2 ,3 ]
机构
[1] Wonkwang Univ Hosp, Dept Cardiovasc Med, 895 Muwang Ro, Iksan 54538, South Korea
[2] Sungkyunkwan Univ, Heart Vasc Stroke Inst, Sch Med, Samsung Med Ctr, 81 Irwon Ro, Seoul 06351, South Korea
[3] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Seoul, South Korea
[4] Sungkyunkwan Univ, Kangbuk Samsung Hosp, Sch Med, Seoul, South Korea
[5] Sungkyunkwan Univ, Samsung Changwon Hosp, Sch Med, Seoul, South Korea
[6] Wonkwang Univ Hosp, Iksan, South Korea
[7] Chungbuk Natl Univ, Chungbuk Natl Univ Hosp, Coll Med, Cheongju, South Korea
[8] Chung Ang Univ, Gwangmyeong Hosp, Coll Med, Gwangmyeong, South Korea
[9] Catholic Univ Korea, Uijeongbu St Marys Hosp, Seoul, South Korea
[10] Keimyung Univ, Dongsan Hosp, Daegu, South Korea
[11] Chung Ang Univ, Chung Ang Univ Hosp, Coll Med, Seoul, South Korea
[12] Chungnam Natl Univ, Chungnam Natl Univ Hosp, Coll Med, Daejeon, South Korea
[13] Inje Univ, Ilsan Paik Hosp, Goyang, South Korea
[14] Hallym Univ, Sacred Heart Hosp, Cardiovasc Ctr, Anyang, South Korea
[15] Seoul Natl Univ, Bundang Hosp, Seongnam, South Korea
[16] Gyeongsang Natl Univ, Gyeongsang Natl Univ Hosp, Sch Med, Jinju, South Korea
[17] Catholic Univ Korea, Incheon St Marys Hosp, Seoul, South Korea
[18] Hanyang Univ, Seoul Hosp, Coll Med, Seoul, South Korea
[19] Hanyang Univ, Myongji Hosp, Goyang, South Korea
[20] Kyung Hee Univ Hosp Gangdong, Seoul, South Korea
[21] Ewha Womans Univ, Coll Med, Seoul, South Korea
[22] Pusan Natl Univ, Yangsan Hosp, Yangsan, South Korea
关键词
angiography; coronary artery; patients; percutaneous coronary intervention; prognosis; DRUG-ELUTING STENTS; DUAL ANTIPLATELET THERAPY; ULTRASOUND GUIDANCE; MYOCARDIAL-INFARCTION; FOCUSED UPDATE; IMPLANTATION; OUTCOMES; DISEASE; IMPACT; MORTALITY;
D O I
10.1161/CIRCINTERVENTIONS.123.013359
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND:The RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) demonstrated that intravascular imaging-guided percutaneous coronary intervention (PCI) improved clinical outcome compared with angiography-guided PCI for patients with complex coronary artery lesions. This study aims to assess whether the prognostic benefit of intravascular imaging-guided procedural optimization persists in patients undergoing PCI for left main coronary artery disease.METHODS:Of 1639 patients enrolled in the RENOVATE-COMPLEX-PCI, 192 patients with left main coronary artery disease were selected for the current prespecified substudy. Selected patients were randomly assigned to either the intravascular imaging-guided PCI group (n=138) or the angiography-guided PCI group (n=54). The primary end point was target vessel failure defined as a composite of cardiac death, target vessel-related myocardial infarction, or clinically driven target vessel revascularization.RESULTS:At a median follow-up of 2.1 years (interquartile range 1.1 to 3.0 years), intravascular imaging-guided PCI was associated with lower incidence of primary end point compared with angiography-guided PCI (6.8% versus 25.1%; hazard ratio, 0.31 [95% CI, 0.13-0.76]; P=0.010). This significant reduction in primary end point was mainly driven by a lower risk of cardiac death or spontaneous target vessel-related myocardial infarction (1.6% versus 12.7%; hazard ratio, 0.16 [95% CI, 0.03-0.82]; P=0.028). Intravascular imaging-guided PCI was independently associated with a lower risk of primary end point, even after adjusting for various clinical factors (hazard ratio, 0.29 [95% CI, 0.12-0.72]; P=0.007).CONCLUSIONS:Intravascular imaging-guided PCI showed clinical benefit over angiography-guided PCI for left main coronary artery disease in reducing the risk of cardiac death, target vessel-related myocardial infarction, or target vessel revascularization.REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT03381872.
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页数:13
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